1
|
Shintoku R, Shimizu T, Aihara M, Asano H, Yamaguchi R, Tsuneoka H, Shimauchi-Ohtaki H, Tosaka M, Yoshimoto Y. Factors associated with decreasing diffusion-weighted imaging-positive area volume after mechanical thrombectomy in patients with large early ischemic changes. Interv Neuroradiol 2024:15910199241245279. [PMID: 38576326 DOI: 10.1177/15910199241245279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the factors associated with decreasing diffusion-weighted imaging (DWI) positive areas in patients with large early ischemic changes after mechanical thrombectomy (MT). MATERIALS AND METHODS This retrospective single-center clinical study was conducted between January 2013 and December 2022. We included consecutive patients who underwent MT for acute large-vessel occlusion of the anterior circulation with low pretreatment DWI-Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) (0-5), effective recanalization [thrombolysis in cerebral infarction (TICI) 2b or TICI3], and magnetic resonance imaging (MRI) acquired before and after MT. We measured the DWI-positive area volume before and after MT. The primary endpoint was the after/before-MT DWI-positive area-volume ratio. RESULTS In total, 28 patients were included in this study. Eight patients (29%) had an after/before-MT DWI-positive area-volume ratio of <1. The median mean apparent diffusion coefficient (ADC) levels of the DWI-positive areas in the groups with a ratio of <1 or >1 were 717 × 10⁶ mm2/s and 637 × 106 mm2/s, respectively (p = 0.011). Multivariate logistic regression analysis showed that ADC level (OR, 1.020 [95% confidence intervals (CIs), 1.001-1.040]; p = 0.040) was an independent predictor of a decreased DWI-positive area after MT. There was a negative correlation between the mean ADC level and the after/before-MT DWI-positive area-volume ratio (p < 0.001, |ρ| = 0.650), and the mean pretreatment ADC cutoff level was 649 × 106 mm2/s (area under the curve (AUC) = 0.806) for predicting a volume ratio of <1. CONCLUSIONS The mean ADC level before-MT correlated with the after/before-MT DWI-positive area-volume ratio. A mean pretreatment ADC cutoff level of 649 × 106 mm2/s predicted a decreased DWI-positive area after MT.
Collapse
Affiliation(s)
- Ryosuke Shintoku
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Shimizu
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirofumi Asano
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Rei Yamaguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Haruka Tsuneoka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
2
|
Alhowaish TS, Alhamadh MS, Alsulayhim A, Alotaibi N, Alrashid AA, Alhabeeb AY, Alqirnas MQ, Alrushid E, Alnafisah MS, Anversha AA. Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome. Vasc Health Risk Manag 2024; 20:1-12. [PMID: 38192438 PMCID: PMC10771733 DOI: 10.2147/vhrm.s435227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background Intraluminal thrombus (ILT) of the cervical arteries is an uncommon finding that can lead to acute or recurrent ischemic stroke. Currently, antithrombotic therapy in the form of antiplatelet and/or anticoagulation is considered the mainstay of treatment, but evidence of which one has a better outcome is lacking. Methods A retrospective cohort study included 28 patients diagnosed with acute stroke or transient ischemic attack with ILT of the extracranial arteries from 2013 to 2022. The primary efficacy outcome was assessed as recurrent stroke, and the primary safety outcome was assessed as hemorrhagic complications. Secondary outcomes were assessed as the resolution of thrombi by CT angiography (CTA) and clinical improvement by the Modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS). Results Out of 28 patients, more than half (57.1%; n = 16) were males with a mean age of 57.8 ± 9.5 years and an average BMI of 26.9 ± 4.5 kg/m2. As initial treatment, twenty-four patients received anticoagulation and four received antiplatelet agents. Recurrent strokes were found in four patients (14.29%), and all were initially treated with anticoagulation. One patient in the anticoagulation group had a significant retroperitoneal hemorrhage. None of the patients in the antiplatelets group had a recurrent stroke or bleeding event. Initial treatment with antiplatelet agents significantly improved the NIHSS on day 7 (P = 0.017). A significant improvement in NIHSS on day 90 was observed in the anticoagulant group (P = 0.011). In the follow-up CTA performed on 24 patients, 18 (75%) showed complete resolution (3 out of 3 (100%) in the antiplatelet group and 15 out of 21 (71.43%) in the anticoagulant group). Conclusion Initial treatment with anticoagulants improves neurologic outcomes in patients with ILT-induced acute ischemic stroke but carries the risk of recurrent stroke and bleeding. However, initial treatment with dual antiplatelet agents appears to have comparable efficacy without sequelae, particularly in atherosclerosis-induced ILT.
Collapse
Affiliation(s)
- Thamer S Alhowaish
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Moustafa S Alhamadh
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Abdullah Alsulayhim
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- Radiology Department, King Abdul Aziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Najla Alotaibi
- College of Public Health, Oregon State University, Corvallis, OR, USA
| | - Azzam Abdulaziz Alrashid
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Abdulrahman Yousef Alhabeeb
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Muhannad Q Alqirnas
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Eythar Alrushid
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Mohammed S Alnafisah
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Ajmal Ali Anversha
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| |
Collapse
|
3
|
Suzuki K, Liebeskind DS, Nishi Y, Kutsuna A, Katano T, Sakamoto Y, Saito T, Aoki J, Matsumoto N, Nishiyama Y, Kimura K. A differential detailed diffusion-weighted imaging-ASPECTS for cerebral infarct volume measurement and outcome prediction. Int J Stroke 2023; 18:1202-1208. [PMID: 37332178 DOI: 10.1177/17474930231185468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) has been used to estimate infarct core volume in acute stroke. However, the same and indiscriminate score deduction for punctate or confluent DWI high-intensity lesion might lead to variation in performance. AIMS To develop and evaluate a differential detailed DWI-ASPECTS method in comparison with the conventional DWI-ASPECTS in core infarct volume measurement and clinical outcome prediction. METHODS We retrospectively recruited patients with acute ischemic stroke (AIS) treated with endovascular treatment between April 2013 and October 2019. In differential detailed DWI-ASPECTS, restricted diffusion lesion that was punctate or less than half of a cortical region (M1-M6) would not lead to subtraction of point. A favorable outcome was modified Rankin Scale score ⩽2 at 90 days after stroke onset. RESULTS Among 298 AIS patients, mean age was 75 years (interquartile range (IQR) 67-82), and 194 patients (65%) were males. Mean infarct core volume was 11 mL (IQR 3-37). Overall, the score by detailed DWI-ASPECTS was significantly higher than conventional DWI-ASPECTS (8 (7-9) vs. 7 (5-9); P < 0.01). The detailed DWI-ASPECTS resulted in a higher correlation coefficient (r) for core infarct volume estimation than the conventional DWI-ASPECTS (r = 0.832 vs. 0.773; P < 0.01). Upon re-classification of those scored ⩽6 in conventional DWI-ASPECTS (n = 134) by detailed DWI-ASPECTS, the rate of favorable outcome in patients with detailed DWI-ASPECTS >6 was significantly higher than those with ⩽6 (29 (48%) vs. 14 (19%); P < 0.01). CONCLUSIONS Detailed DWI-ASPECTS appeared to provide a more accurate infarct core volume measurement and clinical outcome correlation than conventional DWI-ASPECTS among AIS patients treated with endovascular therapy.
Collapse
Affiliation(s)
- Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
- Department of Neurology and UCLA Stroke Center, University of California, Los Angeles, CA, USA
| | - David S Liebeskind
- Department of Neurology and UCLA Stroke Center, University of California, Los Angeles, CA, USA
| | - Yuji Nishi
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Akihito Kutsuna
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Tomonari Saito
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Junya Aoki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | | | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
4
|
Brugnara G, Mihalicz P, Herweh C, Schönenberger S, Purrucker J, Nagel S, Ringleb PA, Bendszus M, Möhlenbruch MA, Neuberger U. Clinical value of automated volumetric quantification of early ischemic tissue changes on non-contrast CT. J Neurointerv Surg 2023; 15:e178-e183. [PMID: 36175015 DOI: 10.1136/jnis-2022-019400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Quantitative and automated volumetric evaluation of early ischemic changes on non-contrast CT (NCCT) has recently been proposed as a new tool to improve prognostic performance in patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). We aimed to test its clinical value compared with the Alberta Stroke Program Early CT Score (ASPECTS) in a large single-institutional patient cohort. METHODS A total of 1103 patients with AIS due to large vessel occlusion in the M1 or proximal M2 segments who underwent NCCT and EVT between January 2013 and November 2019 were retrospectively enrolled. Acute ischemic volumes (AIV) and ASPECTS were generated from the baseline NCCT through e-ASPECTS (Brainomix). Correlations were tested using Spearman's coefficient. The predictive capabilities of AIV for a favorable outcome (modified Rankin Scale score at 90 days ≤2) were tested using multivariable logistic regression as well as machine-learning models. Performance of the models was assessed using receiver operating characteristic (ROC) curves and differences were tested using DeLong's test. RESULTS Patients with a favorable outcome had a significantly lower AIV (median 12.0 mL (IQR 5.7-21.7) vs 18.8 mL (IQR 9.4-33.9), p<0.001). AIV was highly correlated with ASPECTS (rho=0.78, p<0.001) and weakly correlated with the National Institutes of Health Stroke Scale score at baseline (rho=0.22, p<0.001), and was an independent predictor of an unfavorable clinical outcome (adjusted OR 0.97, 95% CI 0.96 to 0.98). No significant difference was found between machine-learning models using either AIV or ASPECTS or both metrics for predicting a good clinical outcome (p>0.05). CONCLUSION AIV is an independent predictor of clinical outcome and presented a non-inferior performance compared with ASPECTS, without clear advantages for prognostic modelling.
Collapse
Affiliation(s)
- Gianluca Brugnara
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Section of Computational Neuroimaging, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Mihalicz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jan Purrucker
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Simon Nagel
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Department of Neurology, Städtisches Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Peter Arthur Ringleb
- Neurology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Section of Computational Neuroimaging, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
5
|
Dumas V, Martin K, Giraud C, Prigent J, Bloch W, Soualmi K, Herpe G, Boucebci S, Neau JP, Guillevin R, Velasco S. Functional outcome in low-ASPECTS (0-5) acute ischemic stroke treated with mechanical thrombectomy: impact of laterality explored in a single-center study. Front Neurol 2023; 14:1205256. [PMID: 37470004 PMCID: PMC10353876 DOI: 10.3389/fneur.2023.1205256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Background There is no consensus regarding the influence of infarct laterality in patients with acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT), particularly in low-ASPECT (0-5) patients who were excluded from the initial MT studies and that participated in dedicated randomized-controlled trials that do not consider the side of the occlusion. We aimed to evaluate the role of infarct laterality on the clinical outcome in low-ASPECT AIS patients treated with MT. Material and methods We retrospectively analyzed our institutional stroke database in our Thrombectomy-Capable Stroke Center (TCSC), including patient characteristics, procedural variables, and outcomes, between January 2015 and January 2022. Patients with acute intracranial ICA and/or proximal MCA occlusions with ASPECT ≤ 5 either on CT or MRI were included and divided into 2 groups according to the location of ischemia. The primary endpoint was a good clinical outcome at 90 days (modified Rankin Scale (mRS) score of 0-3). Results Between January 2015 and November 2021, 817 MT were performed, of which 82 were low-ASPECT (10.0%): 41 left-sided and 41 right-sided strokes. The rates of good clinical outcome were 30.8% (12/41) for the left-sided group and 43.6% (17/41) for the right-sided group, with a p-value of 0.349. The morality rate showed no significant difference between the two groups: 39.0% (16/41) in the right stroke group and 36.6% (15/41) in the left stroke group. Conclusion The clinical outcome was not significantly influenced by stroke laterality. The results of this single-center retrospective study indicate either a lack of strength or equal value in performing mechanical thrombectomy regardless of stroke laterality.
Collapse
Affiliation(s)
- Victor Dumas
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Killian Martin
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Clément Giraud
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
| | - Julia Prigent
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - William Bloch
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Karim Soualmi
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Guillaume Herpe
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Samy Boucebci
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Jean Philippe Neau
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Rémy Guillevin
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Stéphane Velasco
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| |
Collapse
|
6
|
Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Nakamura H, Ushio Y. The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
|
7
|
Neurological Functional Independence After Endovascular Thrombectomy and Different Imaging Modalities for Large Infarct Core Assessment : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:21-29. [PMID: 35920865 DOI: 10.1007/s00062-022-01202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the rate of neurological functional independence (NFI) at 90 days in patients with large infarct core (LIC), which was evaluated by different imaging modalities before endovascular thrombectomy (EVT). METHODS PubMed and EMBASE were searched for original studies on clinical functional outcomes at 90 days in LIC patients who received EVT treatment from inception to 28 September 2021. The pooled NFI rates were calculated using random effects model according to different imaging modalities and criteria. RESULTS We included 34 studies enrolling 2997 LIC patients. The NFI rates were 23% (95% confidence interval, CI 15-32%) and 24% (95% CI 10-38%) when LIC was defined as core volume ≥50 ml and ≥ 70 ml separately on computed tomography perfusion, 36% (95% CI 23-48%) and 21% (95% CI 17-25%) when LIC was defined as core volume ≥ 50 ml and ≥ 70 ml separately on magnetic resonance diffusion-weighted imaging (DWI), 28% (95% CI 24-32%) and 37% (95% CI 21-53%) when LIC was defined as DWI-ASPECTS ≤ 5 and ≤ 6 separately, 23% (95% CI 19-27%) and 32% (95% CI 18-46%) when LIC was defined as NCCT-ASPECTS ≤ 5 and ≤ 6 separately. CONCLUSION Similar NFI rates could be obtained after EVT in LIC patients if proper LIC criteria were select according to the imaging modality.
Collapse
|
8
|
Panni P, Lapergue B, Maïer B, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Blanc R, Consoli A, Eugène F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Darcourt J, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Arquizan C, Gory B. Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke. Clin Neuroradiol 2022; 32:939-950. [PMID: 35412044 DOI: 10.1007/s00062-022-01156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice. METHODS We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr. RESULTS Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009). CONCLUSION The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.
Collapse
Affiliation(s)
- Pietro Panni
- Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy.
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Stephanos Finitsis
- AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Sébastien Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France.,CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Igor Sibon
- Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Raphaël Blanc
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | | | | | | | | | | | | | | | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Department of Neurology, Hôpital Saint-Anne, Paris, France
| | | | | | | | | | - Anthony Le Bras
- Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Neurology, CHBA Bretagne Atlantique, Vannes, France
| | - Valérie Wolff
- Department of Neurology, CHU Strasbourg, Strasbourg, France
| | - Raoul Pop
- Neuroradiology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | | | | | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France
| | | |
Collapse
|
9
|
Safouris A, Palaiodimou L, Szikora I, Kargiotis O, Magoufis G, Psychogios K, Paraskevas G, Spiliopoulos S, Brountzos E, Nardai S, Goyal N, De Sousa DA, Strbian D, Caso V, Alexandrov A, Tsivgoulis G. Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864221139632. [PMID: 36467113 PMCID: PMC9716457 DOI: 10.1177/17562864221139632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with Alberta Stroke Program Early CT Score (ASPECTS) 0-5 has not yet proven safe and effective by clinical trials. OBJECTIVES The aim of the study was to assess whether EVT in AIS patients presenting with low ASPECTS is beneficial. DESIGN Systematic review and meta-analysis of available studies in accordance with the PRISMA statement. DATA SOURCES AND METHODS We have searched MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 28 May 2022 with the aim to calculate (1) modified Rankin scale (mRS) score 0-3 at 3 months, (2) mRS score 0-2 at 3 months, (3) symptomatic intracranial hemorrhage (sICH), and (3) mortality at 3 months. RESULTS Overall, 24 eligible studies were included in the meta-analysis, comprising a total of 2539 AIS patients with ASPECTS 0-5 treated with EVT. The pooled proportion of EVT-treated patients achieving mRS 0-3 at 3 months was calculated at 38.4%. The pooled proportion of EVT-treated patients achieving mRS 0-2 at 3 months was 25.7%. Regarding safety outcomes, sICH occurred in 12.8% of patients. The 3-month pooled mortality was 30%. In pairwise meta-analysis, patients treated with EVT had a higher likelihood of achieving mRS 0-3 at 3 months compared with patients treated with best medical therapy (BMT, OR: 2.41). sICH occurred more frequently in EVT-treated patients compared with the BMT-treated patients (OR: 2.30). Mortality at 3 months was not different between the two treatment groups (OR: 0.71). CONCLUSION EVT may be beneficial for AIS patients with low baseline ASPECTS despite an increased risk for sICH. Further data from randomized-controlled clinical trials are needed to elucidate the role of EVT in this subgroup of AIS patients. REGISTRATION The protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO; Registration Number: CRD42022334417.
Collapse
Affiliation(s)
- Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, Piraeus,
Greece
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
- Aktios Rehabilitation Center, Athens,
Greece
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - István Szikora
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | | | - George Magoufis
- Neuroradiology Department, Metropolitan
Hospital, Piraeus, Greece
| | | | - Georgios Paraskevas
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- Interventional Radiology Department, Attikon
University Hospital, Athens, Greece
| | - Elias Brountzos
- Interventional Radiology Department, Attikon
University Hospital, Athens, Greece
| | - Sándor Nardai
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | - Nitin Goyal
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, The University of
Tennessee Health Science Center and Semmes Murphey Neurologic and Spine
Clinic. Memphis, TN, USA
| | - Diana Aguiar De Sousa
- Stroke Center, Lisbon Central University
Hospital and Faculty of Medicine, University of Lisbon, Lisbon,
Portugal
| | - Daniel Strbian
- Neurological Research Unit, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valeria Caso
- Neurology Unit, ‘M. Bufalini’ Hospital-AUSL
Romagna, Cesena, Italy
| | - Andrei Alexandrov
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon
University Hospital, Rimini 1, Chaidari, 124 62 Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
10
|
Bing F, Berger I, Fabry A, Moroni AL, Casile C, Morel N, M'Biene S, Guellerin J, Pignal-Jacquard C, Vadot W, Rodier G, Delory T, Jund J. Intra- and inter-rater consistency of dual assessment by radiologist and neurologist for evaluating DWI-ASPECTS in ischemic stroke. Rev Neurol (Paris) 2021; 178:219-225. [PMID: 34785042 DOI: 10.1016/j.neurol.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the intra -and inter-rater consistency of radiologist and neurologist working in pairs attributing DWI-ASPECTS (Diffusion Alberta Stroke Program Early CT Score) in patients with acute middle cerebral artery ischemic stroke referred for mechanical thrombectomy, intravenous thrombolysis or bridging therapy. METHODS Five neurologists and 5 radiologists working in pairs and in hour period scored independently and in two reading sessions anonymized DWI-ASPECTS of 80 patients presenting with acute anterior ischaemic stroke in our center. We measured agreement between pairs using intraclass correlation coefficients (ICCs). A Fleiss kappa was used for dichotomized (0-6;7-10) and trichotomized (0-3;4-6;7-10) ASPECTS. The interrater distribution of the score in the trichotomized (0-3;4-6;7-10) ASPECTS was calculated. We determined the interrater (Cohen kappa) and intrarater (Fleiss kappa) agreement on the ASPECTS regions. RESULTS The average DWI-ASPECTS was 6.35 (SD±2.44) for the first reading, and 6.47 (SD±2.44) for the second one. The ICC was 0.853 (95%CI, 0.798-0.896) for the interrater, and 0.862 (95%CI, 0.834-0.885) for the intrarater evaluation. Kappa coefficients were high for dichotomized (k=0.75) and trichotomized (k=0.64) ASPECTS. Evaluators agreement on the ASPECTS category (0-3), (4-6) and (7-10) was 88, 76 and 93% respectively. The anatomic region infarcted was well identified (k=0.70-0.77), except for the internal capsula (k=0.57). Interrater agreement was fair for M5 (k=0.37), moderate for internal capsula (0.52) and substantial for the other regions (0.60-0.79). CONCLUSIONS Reliability of DWI-ASPECTS is good when determined by radiologist and neurologist working in pairs, which corresponds to our current clinical practice. However, discrepancies are possible for cut-off determination, which may impact the indication of thrombectomy, and for the determination of the exact infarcted region. Agreement to propose category (4-6) is lower than for (0-3) and (8-10) ASPECTS categories.
Collapse
Affiliation(s)
- F Bing
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - I Berger
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - A Fabry
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - A-L Moroni
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - C Casile
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - N Morel
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - S M'Biene
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - J Guellerin
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - C Pignal-Jacquard
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - W Vadot
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - G Rodier
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - T Delory
- Clinical Research Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - J Jund
- Medical Information and Evaluation Unit (SIEM), CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| |
Collapse
|
11
|
Aoki J, Sakamoto Y, Suzuki K, Nishi Y, Kutsuna A, Takei Y, Sawada K, Kanamaru T, Abe A, Katano T, Takeshi Y, Nakagami T, Numao S, Kimura R, Suda S, Nishiyama Y, Kimura K. Fluid-Attenuated Inversion Recovery May Serve As a Tissue Clock in Patients Treated With Endovascular Thrombectomy. Stroke 2021; 52:2232-2240. [PMID: 33957776 DOI: 10.1161/strokeaha.120.033374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Junya Aoki
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuji Nishi
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Akihito Kutsuna
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yukako Takei
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kazutaka Sawada
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Takuya Kanamaru
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Arata Abe
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuho Takeshi
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Toru Nakagami
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Shinichiro Numao
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Ryutaro Kimura
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Satoshi Suda
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| |
Collapse
|
12
|
Jing Z, Li H, Huang S, Guan M, Li Y, Lu K, Wu J, Zhong W, Huang L. Outcome of endovascular treatment within and beyond 6 h without perfusion software. Sci Rep 2021; 11:5342. [PMID: 33674715 PMCID: PMC7935958 DOI: 10.1038/s41598-021-84857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/22/2021] [Indexed: 11/09/2022] Open
Abstract
Endovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6-24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6-24 h from symptom onset to groin puncture in this real world study.
Collapse
Affiliation(s)
- Zhen Jing
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Shengming Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Min Guan
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yongxin Li
- Department of Neurology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Kui Lu
- Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
| | - Jianzhou Wu
- Department of Neurology, Yunfu People's Hospital, Yunfu, China
| | - Wangtao Zhong
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li'an Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| |
Collapse
|
13
|
Jiang X, Zhao Z, Zhang Y, Lai L. The Safety and Efficacy of Endovascular Treatment for Patients With ASPECTS<6 in Anterior Circulation Stroke: A Meta-Analysis and Subgroup Analysis by Imaging Techniques. J Stroke Cerebrovasc Dis 2020; 29:105122. [PMID: 32912548 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Endovascular treatment (EVT) is merely recommended as class of recommendation IIb for patients with ASPECTS <6 according to the American Heart Association guideline 2019. In addition, the best determined imaging technique for EVT in patient with ASPECTS<6 remains unknown. The objective of this study was to define the safety and efficacy of EVT for patients with ASPECTS<6 and investigate the superiority between MRI and CT for patient selection. METHODS A systematic search of PubMed, EMBASE, The Cochrane Library and other additional sources was performed for studies published with no publication period. Our study was conducted corresponding to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMA) guidelines. The analysis was performed using the Comprehensive Meta-Analysis (CMA) 2.0. RESULTS Five studies reporting data from 844 participants were included in our analysis according to the inclusion criteria. Consequently, EVT was associated with statistically significant higher functional independence compared with MT (OR 5.401, 95% CI 3.227-9.041). Whereas EVT was found to be related to lower mortality compared with MT based on eligible data (OR 0.461, 95% CI 0.329-0.647). No significant difference was identified in sICH between EVT and MT (OR 1.075, 95% CI 0.452-2.558). CONCLUSION According to the results of our study, we suggested that EVT is a preferred therapy in ACS patients with ASPECTS<6 in consideration of efficacy and safety. Furthermore, MRI did not show superiority over CT as no statistical difference was detected in all subgroups.
Collapse
Affiliation(s)
- Xin Jiang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, 330006 Nanchang, Jiangxi, PR China; The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Zixu Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, 330006 Nanchang, Jiangxi, PR China; Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Ying Zhang
- The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Lingfeng Lai
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, 330006 Nanchang, Jiangxi, PR China.
| |
Collapse
|
14
|
Aoki J, Suzuki K, Kanamaru T, Katano T, Kutsuna A, Sakamoto Y, Suda S, Nishiyama Y, Morita N, Harada M, Nagahiro S, Kimura K. Impact of complete recanalization on clinical recovery in cardioembolic stroke patients with M2 occlusion. J Neurol Sci 2020; 415:116873. [PMID: 32413798 DOI: 10.1016/j.jns.2020.116873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion. METHODS Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1.5 h after tPA. Partial recanalization was defined as TICI ≥2b or > 50% recanalization on MRA. At 3 months, favorable outcome was defined as a modified Rankin Scale score ≤ 2. RESULT Data on 121 patients were analyzed. EVT-alone was in 38 patients; combined EVT and tPA in 28; and tPA-alone in 55. Complete recanalization was achieved in 27 (22%), partial recanalization in 48 (40%), and no-to-limited recanalization in 46 (38%). At 3 months, 51% of patients had favorable outcomes, and this rate was significantly higher in the complete recanalization group than in the partial and no-to-limited recanalization groups (75% vs. 41% vs. 49%, p = .043). Multivariate regression analysis showed that complete recanalization was an independent parameter related to favorable outcomes (odds ratio 4.78, 95% CI: 1.16-19.73, p = .030). However, combined complete and partial recanalization was not associated with favorable outcomes (odds ratio 1.49, 95% CI 0.53-4.22, p = .449). CONCLUSION Complete recanalization, but not partial recanalization, at the end of EVT and tPA therapy is associated with favorable outcomes in patients with M2 occlusion.
Collapse
Affiliation(s)
- Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
| | - Kentaro Suzuki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takuya Kanamaru
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Katano
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Akihito Kutsuna
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | | | - Masafumi Harada
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Tokushima University Hospital, Tokushima University, Tokushima, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| |
Collapse
|
15
|
Puig J, Shankar J, Liebeskind D, Terceño M, Nael K, Demchuk AM, Menon B, Dowlatshahi D, Leiva-Salinas C, Wintermark M, Thomalla G, Silva Y, Serena J, Pedraza S, Essig M. From "Time is Brain" to "Imaging is Brain": A Paradigm Shift in the Management of Acute Ischemic Stroke. J Neuroimaging 2020; 30:562-571. [PMID: 32037629 DOI: 10.1111/jon.12693] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022] Open
Abstract
Arterial recanalization to restore the blood supply and limit the brain damage is the primary goal in the management of acute ischemic stroke (AIS). Since the publication of pivotal randomized clinical trials in 2015, endovascular thrombectomy has become part of the standard of care in selected cases of AIS from large-vessel occlusions up to 6 hours after the onset of symptoms. However, the association between endovascular reperfusion and improved functional outcome is not strictly time dependent. Rather than on rigid time windows, candidates should be selected based on vascular and physiologic information. This approach places imaging data at the center of treatment decisions. Advances in imaging-based management of AIS provide crucial information about vessel occlusion, infarct core, ischemic penumbra, and degree of collaterals. This information is invaluable in identifying patients who are likely to benefit from reperfusion therapies and excluding those who are unlikely to benefit or are at risk of adverse effects. The approach to reperfusion therapies continues to evolve, and imaging is acquiring a greater role in the diagnostic work-up and treatment decisions as shown in recent clinical trials with extended time window. The 2018 American Heart Association/American Stroke Association guidelines reflect a paradigm shift in the management of AIS from "Time is Brain" to "Imaging is Brain." This review discusses the essential role of multimodal imaging developing from recent trials on therapy for AIS.
Collapse
Affiliation(s)
- Josep Puig
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, Hospital Universitari Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, CA
| | - Mikel Terceño
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy Menon
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, CA
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yolanda Silva
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Joaquin Serena
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Salvador Pedraza
- Department of Radiology, Hospital Universitari Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Marco Essig
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
16
|
Kuang H, Qiu W, Najm M, Dowlatshahi D, Mikulik R, Poppe AY, Puig J, Castellanos M, Sohn SI, Ahn SH, Calleja A, Jin A, Asil T, Asdaghi N, Field TS, Coutts S, Hill MD, Demchuk AM, Goyal M, Menon BK. Validation of an automated ASPECTS method on non-contrast computed tomography scans of acute ischemic stroke patients. Int J Stroke 2019; 15:528-534. [DOI: 10.1177/1747493019895702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The Alberta Stroke Program Early CT Score (ASPECTS) is a systematic method of assessing the extent of early ischemic change on non-contrast computed tomography in patients with acute ischemic stroke. Our objective was to validate an automated ASPECTS scoring method we recently developed on a large data set. Materials and methods We retrospectively collected 602 acute ischemic stroke patients’ non-contrast computed tomography scans. Expert ASPECTS readings on non-contrast computed tomography were compared to automated ASPECTS. Statistical analyses on the total ASPECTS, region level ASPECTS, and dichotomized ASPECTS (≤4 vs. >4) score were conducted. Results In total, 602 scans were evaluated and 6020 (602 × 10) ASPECTS regions were scored. Median time from stroke onset to computed tomography was 114 min (interquartile range: 73–183 min). Total ASPECTS for the 602 patients generated by the automated method agreed well with expert readings (intraclass correlation coefficient): 0.65 (95% confidence interval (CI): 0.60–0.69). Region level analysis showed that the automated method yielded accuracy of 81.25%, sensitivity of 61.13% (95% CI: 58.4%–63.8%), specificity of 86.56% (95% CI: 85.6%–87.5%), and area under curve of 0.74 (95% CI: 0.73–0.75). For dichotomized ASPECTS (≤4 vs. >4), the automated method demonstrated sensitivity 97.21% (95% CI: 95.4%–98.4%), specificity 57.81% (95% CI: 44.8%–70.1%), accuracy 93.02%, and area under the curve of 0.78 (95% CI: 0.74–0.81). For each individual region (M1–6, lentiform, insula, and caudate), the automated method demonstrated acceptable performance. Conclusion The automated system we developed approached the stroke expert in performance when scoring ASPECTS on non-contrast computed tomography scans of acute ischemic stroke patients.
Collapse
Affiliation(s)
- Hulin Kuang
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Wu Qiu
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mohamed Najm
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Mikulik
- International Clinical Research Center, Department of Neurology, St Ann’s University Hospital, Masaryk University, Brno, Czech Republic
| | - Alex Y Poppe
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
| | - Josep Puig
- IDI-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Mar Castellanos
- IDI-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Sung I Sohn
- Department of Neurology, Keimyung University, Daegu, South Korea
| | - Seong H Ahn
- Department of Neurology, Keimyung University, Daegu, South Korea
| | - Ana Calleja
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Albert Jin
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Talip Asil
- Bezmialem Vakif Univesitesi Noroloji, Istanbul, Turkey
| | - Negar Asdaghi
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Thalia S Field
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelagh Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
17
|
Kim JT, Cho BH, Choi KH, Park MS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Nah HW, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee JS, Lee J, Bae HJ, Cho KH. Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke. Stroke 2019; 50:365-372. [PMID: 30612537 DOI: 10.1161/strokeaha.118.023173] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection. Methods- Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0-2 and 0-1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality). Results- Ultimately, 1265 patients (age, 69±12 yrs; men, 55%) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11-19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1% versus 38.5%), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8% versus 7.7%, P=0.01 for SICH; 15.4% versus 20.9%, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality ( P=0.051); however, the MRI group was less likely to develop SICH than the CTA group ( P=0.01; odds ratio, 0.34 [95% CI, 0.17-0.77]). Conclusions- Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.
Collapse
Affiliation(s)
- Joon-Tae Kim
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., B.-H.C., K.-H. Choi, M.-S.P., K.-H. Cho)
| | - Bang-Hoon Cho
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., B.-H.C., K.-H. Choi, M.-S.P., K.-H. Cho)
| | - Kang-Ho Choi
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., B.-H.C., K.-H. Choi, M.-S.P., K.-H. Cho)
| | - Man-Seok Park
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., B.-H.C., K.-H. Choi, M.-S.P., K.-H. Cho)
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., H.-J.B.)
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea (J.-M.P., K.K.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea (J.-M.P., K.K.)
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.)
| | - Hyun-Wook Nah
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.)
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.)
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Korea (J.C.C.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Korea (J.-H.K., W.J.K.)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Korea (J.-H.K., W.J.K.)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., M.-J.Y.)
| | - Min-Ju Yeo
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., M.-J.Y.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul (J.L.)
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., H.-J.B.)
| | - Ki-Hyun Cho
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., B.-H.C., K.-H. Choi, M.-S.P., K.-H. Cho)
| |
Collapse
|
18
|
Kim JT, Cho BH, Choi KH, Park MS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Nah HW, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Lee JS, Lee J, Bae HJ, Saver JL, Cho KH. Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy. Eur J Neurol 2019; 27:343-351. [PMID: 31535427 DOI: 10.1111/ene.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 09/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. METHODS This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8-10), moderate (5-7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0-2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. RESULTS Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15). CONCLUSIONS Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.
Collapse
Affiliation(s)
- J-T Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - B-H Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - K-H Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - M-S Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - B J Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - J-M Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - K Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - S J Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - J G Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - J-K Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - D-H Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - H-W Nah
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - T H Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - S-S Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - K B Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - J Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - K-S Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Y-J Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - H-K Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - B-C Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - K-H Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - M S Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - D-E Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - W-S Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - J C Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - J-H Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea
| | - W-J Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea
| | - D-I Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - S I Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - J-H Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - J S Lee
- Department of Neurology, Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J Lee
- Department of Neurology, Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - H-J Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - J L Saver
- Department of Neurology, Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - K-H Cho
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
19
|
Cagnazzo F, Derraz I, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Bonafe A, Costalat V. Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. J Neurointerv Surg 2019; 12:350-355. [DOI: 10.1136/neurintsurg-2019-015237] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/03/2022]
Abstract
BackgroundIt is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0–2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0–6.ObjectiveTo assess the impact of MT in patients with pretreatment ASPECTS 0–6.MethodsAccording to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0–6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0–2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates.ResultsWe included 17 studies and 1378 patients with ASPECTS 0–6 (1194 MT, 184 medical management). The rate of mRS 0–2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0–2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0–2 was 17.1% in patients with ASPECTS 0–4: 22.1% and 13.9% of patients with ASPECTS 4 and 0–3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b–3) gave higher odds of mRS 0–2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged <70 years had higher rates of mRS 0–2 than those aged >70 years (40.3% vs 16.2%).ConclusionsPatients with ASPECTS 0–6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome.
Collapse
|
20
|
Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 5 can benefit from endovascular treatment: a single-center experience and literature review. Neuroradiology 2019; 61:451-459. [PMID: 30725121 PMCID: PMC6431332 DOI: 10.1007/s00234-019-02177-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The recommendation strength of the guidelines for mechanical thrombectomy among patients with large pre-treatment core infarct is weak. We evaluated the safety and outcome of endovascular treatment for acute ischemic stroke with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤ 5. METHODS Data on acute ischemic stroke patients with DWI-ASPECTS ≤ 5 who underwent endovascular treatment within 6 h, or presented an arterial spin labeling-DWI (ASL-DWI) mismatch within 12 h, at our center were retrospectively collected. We report the clinical characteristics and outcome of every patient, and review the relevant literature. RESULTS Among the 19 patients who were enrolled, all experienced successful reperfusion, and 10 achieved a favorable outcome (modified Rankin scale (mRS) ≤ 2). Two patients presented with symptomatic intracranial hemorrhage (sICH); both of them had a poor outcome (mRS > 2). CONCLUSION Acute ischemic stroke patients with large DWI lesions caused by large vessel occlusion can achieve a favorable clinical outcome with endovascular treatment if recanalization is performed within 6 h, or after 6 h in case of an ASL-DWI mismatch.
Collapse
|
21
|
Kuang H, Najm M, Chakraborty D, Maraj N, Sohn SI, Goyal M, Hill MD, Demchuk AM, Menon BK, Qiu W. Automated ASPECTS on Noncontrast CT Scans in Patients with Acute Ischemic Stroke Using Machine Learning. AJNR Am J Neuroradiol 2019; 40:33-38. [PMID: 30498017 DOI: 10.3174/ajnr.a5889] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Alberta Stroke Program Early CT Score (ASPECTS) was devised as a systematic method to assess the extent of early ischemic change on noncontrast CT (NCCT) in patients with acute ischemic stroke (AIS). Our aim was to automate ASPECTS to objectively score NCCT of AIS patients. MATERIALS AND METHODS We collected NCCT images with a 5-mm thickness of 257 patients with acute ischemic stroke (<8 hours from onset to scans) followed by a diffusion-weighted imaging acquisition within 1 hour. Expert ASPECTS readings on DWI were used as ground truth. Texture features were extracted from each ASPECTS region of the 157 training patient images to train a random forest classifier. The unseen 100 testing patient images were used to evaluate the performance of the trained classifier. Statistical analyses on the total ASPECTS and region-level ASPECTS were conducted. RESULTS For the total ASPECTS of the unseen 100 patients, the intraclass correlation coefficient between the automated ASPECTS method and DWI ASPECTS scores of expert readings was 0.76 (95% confidence interval, 0.67-0.83) and the mean ASPECTS difference in the Bland-Altman plot was 0.3 (limits of agreement, -3.3, 2.6). Individual ASPECTS region-level analysis showed that our method yielded κ = 0.60, sensitivity of 66.2%, specificity of 91.8%, and area under curve of 0.79 for 100 × 10 ASPECTS regions. Additionally, when ASPECTS was dichotomized (>4 and ≤4), κ = 0.78, sensitivity of 97.8%, specificity of 80%, and area under the curve of 0.89 were generated between the proposed method and expert readings on DWI. CONCLUSIONS The proposed automated ASPECTS scoring approach shows reasonable ability to determine ASPECTS on NCCT images in patients presenting with acute ischemic stroke.
Collapse
Affiliation(s)
- H Kuang
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - M Najm
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - D Chakraborty
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - N Maraj
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - S I Sohn
- Department of Neurology (S.I.S.), Keimyung University, Daegu, South Korea
| | - M Goyal
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
- Department of Clinical Neurosciences, Department of Radiology (M.D.H., A.M.D., M.G., B.K.M.)
- Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H., A.M.D., M.G., B.K.M.)
| | - M D Hill
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
- Department of Clinical Neurosciences, Department of Radiology (M.D.H., A.M.D., M.G., B.K.M.)
- Department of Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H., A.M.D., M.G., B.K.M.)
| | - A M Demchuk
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
- Department of Clinical Neurosciences, Department of Radiology (M.D.H., A.M.D., M.G., B.K.M.)
- Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H., A.M.D., M.G., B.K.M.)
| | - B K Menon
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
- Department of Clinical Neurosciences, Department of Radiology (M.D.H., A.M.D., M.G., B.K.M.)
- Department of Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H., A.M.D., M.G., B.K.M.)
| | - W Qiu
- From the Calgary Stroke Program (H.K., W.Q., M.N., D.C., N.M., M.G., M.D.H., A.M.D., B.K.M.)
| |
Collapse
|
22
|
Chen Z, Zhang R, Zhou Y, Gong X, Zhang M, Shi F, Yu X, Lou M. Patients With Ischemic Core ≥70 ml Within 6 h of Symptom Onset May Still Benefit From Endovascular Treatment. Front Neurol 2018; 9:933. [PMID: 30455665 PMCID: PMC6230959 DOI: 10.3389/fneur.2018.00933] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/15/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Large core is associated with poor outcome in acute ischemic stroke (AIS) patients. It is unclear whether endovascular treatment (EVT) could bring benefits to patients with core volume ≥70 ml before treatment. We aimed to compare the impact of EVT with intravenous thrombolysis (IVT) on the outcome in patients with core volume ≥70 ml. Methods: We included consecutive anterior circulation AIS patients who underwent MR or CT perfusion within 6 h post stroke onset, which revealed a core ≥70 ml before reperfusion therapy. Good outcome was defined by modified Rankin Scale of 0 to 2 at 90-day. Reperfusion was defined as a reduction in hypoperfusion volume of ≥70% between baseline and 24 h. Results: One hundred four patients were included. Among them, 76 received IVT only, and 28 received EVT. After adjusting for age, NIHSS score, baseline core volume and onset to imaging time, patients in EVT group were more likely to achieve good outcome compared to IVT patients (OR, 3.875; 95% Cl 1.068-14.055, p = 0.039). More patients in EVT group achieved recanalization (84.0 vs. 58.5%, p = 0.027) and reperfusion (66.7 vs. 33.3%, p = 0.010) than in IVT group. Reperfusion also independently predicted good outcome (OR, 7.718; 95% Cl 1.713-34.772, p = 0.008). All patients with good outcome achieved recanalization at 24 h. Conclusions: Our data indicated that patients with core volume ≥70 ml might still benefit from EVT, which was related to its high reperfusion rate.
Collapse
Affiliation(s)
- Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaoxian Gong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Meixia Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Feina Shi
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| |
Collapse
|
23
|
The Processing Time for Recanalization and Size of Ischemic Lesions on DWI is Related With Complete Reperfusion After Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2018; 27:3266-3271. [PMID: 30154050 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022] Open
Abstract
Recent studies demonstrated that modified thrombolysis in cerebral infarction (TICI) 3 reperfusion have better functional outcomes than modified TICI 2b after mechanical thrombectomy in acute ischemic stroke with large vessel occlusion. The purpose of this study was to determine significant factors to forecast the presence of complete reperfusion after mechanical thrombectomy based on multimodal magnetic resonance imaging (MRI). We investigated 96 consecutive patients with acute large intracranial artery occlusion of anterior circulation who based on multimodal MRI. Also, we compared clinical and radiologic parameters between patients with modified TICI 3 and those with modified TICI 0-2b. Among 96 eligible subjects received mechanical thrombectomy, 39 patients (40.6%) showed complete reperfusion and 57 partial or nonreperfusion (mTICI 2b-26, mTICI 2a-9, mTICI 1-8, and mTICI 0-14) after mechanical thrombectomy. Patients with mTICI 3 had significantly smaller initial Diffusion weighted images (DWI) lesion volume (P < .01) and much shorter time interval from onset to reperfusion (P < .01) than those patients with mTICI (0-2b). In multivariate analysis, smaller initial DWI volume (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.23-2.57; P < .01) and faster reperfusion time (OR, 1.07; 95% CI 1.01-1.14; P = .015) had an independence significance for complete reperfusion after mechanical thrombectomy. In this study, the ischemic lesion volume on DWI and faster processing time are critical factor to predict the state of complete reperfusion after mechanical thrombectomy.
Collapse
|
24
|
Aoki J, Suzuki K, Kanamaru T, Takayama Y, Katano T, Kutsuna A, Suda S, Nishiyama Y, Okubo S, Kimura K. [To optimize the initial assessment for stroke patients transferred from general hospital may improve the clinical outcome after endovascular thrombectomy]. Rinsho Shinkeigaku 2018; 58:471-478. [PMID: 30068813 DOI: 10.5692/clinicalneurol.cn-001181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rapid adaption of endovascular thrombectomy (EVT) is essential for patients with large arterial occlusion (LAO). Although patients transferred need longer transportation, they have an advantage of preadmission diagnosis regarding arterial occlusion. The aim of the present study is to evaluate whether optimizing the assessment at comprehensive center for patients transferred may improve the clinical outcome after EVT. Data on consecutive patients treated with EVT between September 2014 and May 2017 were studied. Generally, we have two distinct protocols for EVT candidates: 1) the transfer group, patients are directly taken to the CT and escorted to the angiography room; and 2) the direct group, patients receive the routine emergent evaluation and examined with MRI/MRA. Good outcome was defined as modified Rankin Scale score ≤1 at 3 months. Thirty-one (29%) patients were classified into the transfer group and the 77 (71%) were into the direct group. Although the onset to door time was longer in the transfer group (175 [137-275] min. vs. 76 [51-260] min, P = 0.001), the rate of good outcome was similar between the 2 groups (41% vs. 25%, P = 0.205). By multivariate regression analysis, the onset to reperfusion time was the independent factor (odds ratio 0.982, 95%CI: 0.967-0.998, P = 0.026) associated with good outcome, while transfer itself was not the independent parameter (odds ratio 0.732, 95%CI: 0.125-4.291, P = 0.730). Regarding time parameters, door to picture time (11 [7-24] min vs. 27 [21-39] min., P < 0.001) and picture to puncture time (27 [18-60] min. vs. 54 [39-78] min, P < 0.001) were shorter in the transfer group. Thus, the onset to puncture time (234 [177-299] min. vs. 170 [125-367] min, P = 0.063) and the onset to reperfusion time (271 [208-352] min. vs. 237 [159-382] min., P = 0.183) were similar between the 2 groups. Shortening the initial evaluation at comprehensive stroke center can provide a good outcome for patients transferred.
Collapse
Affiliation(s)
- Junya Aoki
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Kentaro Suzuki
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Takuya Kanamaru
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Yohei Takayama
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Takehiro Katano
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Akihito Kutsuna
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Satoshi Suda
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Yasuhiro Nishiyama
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Seiji Okubo
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| | - Kazumi Kimura
- Department of Neurological Science, Nippon Medical School Graduate School of Medicine
| |
Collapse
|
25
|
Ohta T, Morimoto M, Okada K, Fukuda M, Onishi H, Masahira N, Matsuoka T, Tsuno T, Takemura M. Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients. Neurol Med Chir (Tokyo) 2018; 58:156-163. [PMID: 29479041 PMCID: PMC5929913 DOI: 10.2176/nmc.oa.2017-0203] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI. Patient characteristics and clinical outcomes were compared between the treatment groups. Significant dependence was defined as a modified Rankin scale score ≥3 at 90 days. As a result, 33 patients underwent mechanical thrombectomy and 50 received medical management. In the mechanical thrombectomy group, the variable of lower DWI-ASPECTS (5, 4–6 vs. 8, 7–8, P < 0.001), especially ≤6, was significantly associated with poor prognosis. However, compared with patients of DWI-ASPECTS ≤ 6 who received medical management, there were significantly fewer patients with poor outcomes in thrombectomy (dependent in 11 of 15 vs. 23 of 23, respectively; P = 0.019). Although patients with lower pretreatment DWI-ASPECTS could benefit less from thrombectomy, their outcomes were still better than medical management. Therefore, mechanical thrombectomy could be considered in some patients with low pretreatment DWI-ASPECTS.
Collapse
Affiliation(s)
- Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center
| | | | - Kenji Okada
- Department of Neurosurgery, Kochi Health Sciences Center
| | - Maki Fukuda
- Department of Neurosurgery, Kochi Health Sciences Center
| | - Hirokazu Onishi
- Department of Emergency Medicine, Kochi Health Sciences Center
| | | | | | - Takaya Tsuno
- Department of Neurosurgery, Kochi Health Sciences Center
| | | |
Collapse
|
26
|
Manceau PF, Soize S, Gawlitza M, Fabre G, Bakchine S, Durot C, Serre I, Metaxas GE, Pierot L. Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS ≤ 5)? Eur J Neurol 2017; 25:105-110. [DOI: 10.1111/ene.13460] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
Affiliation(s)
- P. -F. Manceau
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Soize
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - M. Gawlitza
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. Fabre
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Bakchine
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - C. Durot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - I. Serre
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. -E. Metaxas
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - L. Pierot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| |
Collapse
|
27
|
Ryu CW, Shin HS, Park S, Suh SH, Koh JS, Choi HY. Alberta Stroke Program Early CT Score in the Prognostication after Endovascular Treatment for Ischemic Stroke: A Meta-analysis. Neurointervention 2017; 12:20-30. [PMID: 28316866 PMCID: PMC5355457 DOI: 10.5469/neuroint.2017.12.1.20] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/20/2017] [Indexed: 01/19/2023] Open
Abstract
Purpose The Alberta Stroke Program Early CT Score (ASPECTS) was devised to quantify the extent of early ischemic changes in the middle cerebral artery territory on brain CT. We performed a systematic review and meta-analysis of studies that presented clinical outcomes and baseline ASPECTS in ischemic stroke patients managed with endovascular methods to validate the use of ASPECTS for risk prognostication. Materials and Methods We searched the MEDLINE, EMBASE, and Cochran databases for observational or interventional studies that reported clinical outcomes and baseline ASPECTS in ischemic stroke patients treated with endovascular methods. Data were pooled to perform a meta-analysis for comparisons of clinical outcomes between high and low ASPECTS patients. Results A meta-analysis of 13 studies (six observational and seven interventional) revealed favorable outcomes (mRS sore 0-2 at 90 days) for high baseline ASPECTS (odds ratio=2.22; 95% CI: 1.74-2.86). Conclusion High ASPECTS is a predictor of favorable outcome after endovascular therapy for ischemic stroke.
Collapse
Affiliation(s)
- Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hee Shup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Soonchan Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
28
|
Hwang YH, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of Baseline Ischemia on Outcome in Older Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke. J Clin Neurol 2017; 13:162-169. [PMID: 28271641 PMCID: PMC5392458 DOI: 10.3988/jcn.2017.13.2.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The outcome for older stroke patients who undergo endovascular revascularization remains unsatisfactory. We aimed to determine the effect of the extent of baseline ischemia on outcome according to age, testing the hypothesis that the restorative capacity for recovery is only marginal in older patients. METHODS Two hundred and thirteen patients who underwent endovascular revascularization due to occlusion in the M1 segment of the middle cerebral artery (with or without internal carotid artery occlusions) were selected for analysis. Patients were categorized into three age groups: group A (<66 years), group B (66-75 years), and group C (>75 years). Using pretreatment diffusion-weighted imaging (DWI), the Alberta Stroke Program Early CT Score (ASPECTS) and lesion volume were independently measured and analyzed in relation to a favorable outcome. RESULTS A favorable outcome was achieved in 111 of 213 patients overall: in 60 of the 94 (63.8%) patients in group A, in 36 of the 70 (51.4%) patients in group B, and in 15 of the 49 (30.6%) patients in group C (p=0.001). In older stroke patients (group C), a DWI ASPECTS ≥9 and lesion volume ≤5 mL were found to predict a favorable outcome, which was more restrictive than the cutoffs for their younger counterparts (groups A and B; DWI ASPECTS ≥8 and lesion volume ≤20 mL). CONCLUSIONS The age-adjusted pretreatment DWI lesion volume and ASPECTS may represent useful surrogate markers for functional outcome according to age. The use of more-restrictive inclusion criteria for older stroke patients could be warranted, although larger studies are necessary to confirm these findings.
Collapse
Affiliation(s)
- Yang Ha Hwang
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.
| | - Yong Won Kim
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea
| | - Dong Hun Kang
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, Korea
| | - Yong Sun Kim
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, Korea
| | - David S Liebeskind
- UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
29
|
Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Rev Neurol (Paris) 2017; 173:106-113. [PMID: 28238346 DOI: 10.1016/j.neurol.2016.06.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 01/13/2023]
Abstract
Recent randomized trials have demonstrated the efficacy of stent retriever thrombectomy, in association with intravenous thrombolysis, in acute ischemic stroke related to the occlusion of the distal internal carotid artery or the proximal middle cerebral artery within six hours of symptom onset. Mechanical thrombectomy should be performed as soon as possible after symptom onset. High age alone should not be considered as a contraindication for mechanical thrombectomy. Mechanical thrombectomy is recommended in acute ischemic stroke patients with large vessel occlusions and salvageable brain tissue if intravenous thrombolysis is contraindicated. Re-organization of stroke care systems is needed to provide rapid access to endovascular therapy equitably to all eligible patients.
Collapse
Affiliation(s)
- L Derex
- Unité neurovasculaire, service de neurologie, hôpital Neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
| | - T-H Cho
- Unité neurovasculaire, service de neurologie, hôpital Neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| |
Collapse
|
30
|
Schröder J, Thomalla G. A Critical Review of Alberta Stroke Program Early CT Score for Evaluation of Acute Stroke Imaging. Front Neurol 2017; 7:245. [PMID: 28127292 PMCID: PMC5226934 DOI: 10.3389/fneur.2016.00245] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023] Open
Abstract
Assessment of ischemic stroke lesions on computed tomography (CT) or MRI using the Alberta Stroke Program Early CT Score (ASPECTS) is widely used to guide acute stroke treatment. We aimed to review the current evidence on ASPECTS. Originally, the score was developed for standardized lesion assessment on non-contrast CT (NCCT). Early studies described ASPECTS as a predictor of functional outcome and symptomatic intracranial hemorrhage after iv-thrombolysis with a threshold of ≤7 suggested to identify patients at high risk. Following studies rather pointed toward a linear relationship between ASPECTS and functional outcome. ASPECTS has also been applied to assess perfusion CT and diffusion-weighted MRI (DWI). Cerebral blood volume ASPECTS proved to be the best predictor of outcome, outperforming NCCT-ASPECTS in some studies. For DWI-ASPECTS varying thresholds to identify patients at risk for poor outcome were reported. ASPECTS has been used for patient selection in three of the five groundbreaking trials proving efficacy of mechanical thrombectomy published in 2015. ASPECTS values predict functional outcome after thrombectomy. Moreover, treatment effect of thrombectomy appears to depend on ASPECTS values being smaller or not present in low ASPECTS, while patients with ASPECTS 5–10 do clearly benefit from mechanical thrombectomy. However, as patients with low ASPECTS values were excluded from recent trials data on this subgroup is limited. There are several limitations to ASPECTS addressed in a growing number of studies. The score is limited to the anterior circulation, the template is unequally weighed and correlation with lesion volume depends on lesion location. Overall ASPECTS is a useful and easily applicable tool for assessment of prognosis in acute stroke treatment and to help guide acute treatment decisions regardless whether MRI or CT is used. Patients with low ASPECTS values are unlikely to achieve good outcome. However, methodological constraints of ASPECTS have to be considered, and based on present data, a clear cutoff value to define “low ASPECTS values” cannot be given.
Collapse
Affiliation(s)
- Julian Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| |
Collapse
|
31
|
Han M, Choi JW, Rim NJ, Kim SY, Suh HI, Lee KS, Hong JM, Lee JS. Cerebral infarct volume measurements to improve patient selection for endovascular treatment. Medicine (Baltimore) 2016; 95:e4702. [PMID: 27583902 PMCID: PMC5008586 DOI: 10.1097/md.0000000000004702] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients who have large cerebral infarctions may not be good candidates for endovascular treatment. Various methods for determining infarct volume have been used in clinical studies. We evaluated the effectiveness of several methods for measuring infarct volume, especially regarding futile outcomes despite endovascular treatment.Patients with acute ischemic stroke in unilateral anterior circulation territory who were treated with intra-arterial thrombectomy were included. For assessing infarct volume, the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) scoring system was applied to images obtained by noncontrast computed tomography (NCCT), postcontrast CT (PCCT), and diffusion-weighted imaging (DWI). DWI stroke volume was semiquantitatively measured with the manually outlined hyperintense lesion. Infarct core volume was calculated with a threshold apparent diffusion coefficient value of 600 × 10 mm/s. Intraclass correlation coefficients (ICC) were estimated to assess inter-reader reliability for ASPECTS scoring and DWI stroke volume. Receiver operating characteristic (ROC) curve analyses, and univariable and multivariable comparative analyses, were performed with each evaluation method to predict futile outcome (modified Rankin Scale score 5-6).The mean age of the included 79 patients was 65.1 ± 15.7 years. Among them, 55 (69.6%) patients demonstrated successful reperfusion after intra-arterial thrombectomy, but 34 (43.0%) patients had futile outcomes. Inter-reader agreement was excellent for measurement of the DWI stroke volume (ICC, 0.973), DWI ASPECTS (0.940), and PCCT ASPECTS (0.859), but was moderate for NCCT ASPECTS (0.694). Regarding prediction of futile outcomes, area under ROC curve was 0.551 on NCCT ASPECTS and it was significantly smaller than that in PCCT ASPECTS (area under ROC 0.651, P = 0.030), DWI ASPECTS (0.733, P = 0.003), DWI stroke volume (0.702, P = 0.022), and infarct core volume (0.702, P = 0.021). Besides old age and high National Institutes of Health Stroke Scale score on admission, MRI parameters such as DWI ASPECTS and infarct core volume indicating large volumes were independently associated with futile outcomes in multivariable analyses.DWI ASPECTS can be a good parameter predicting futility, which is easily measured and has high prediction power.
Collapse
Affiliation(s)
| | | | | | | | - Hong-Il Suh
- Department of Neurology, Ajou University School of Medicine and Hospital, Suwon, Republic of Korea
| | - Kyu Sun Lee
- Department of Neurology, Ajou University School of Medicine and Hospital, Suwon, Republic of Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine and Hospital, Suwon, Republic of Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine and Hospital, Suwon, Republic of Korea
- Correspondence: Jin Soo Lee, Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center; San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Korea (e-mail: )
| |
Collapse
|
32
|
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Devlin TG, Lopes DK, Reddy V, du Mesnil de Rochemont R, Jahan R. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke 2016; 10:439-48. [PMID: 25777831 PMCID: PMC4405096 DOI: 10.1111/ijs.12459] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/06/2015] [Indexed: 01/19/2023]
Abstract
Rationale Early reperfusion in patients experiencing acute ischemic stroke is critical, especially for patients with large vessel occlusion who have poor prognosis without revascularization. Solitaire™ stent retriever devices have been shown to immediately restore vascular perfusion safely, rapidly, and effectively in acute ischemic stroke patients with large vessel occlusions. Aim The aim of the study was to demonstrate that, among patients with large vessel, anterior circulation occlusion who have received intravenous tissue plasminogen activator, treatment with Solitaire revascularization devices reduces degree of disability 3 months post stroke. Design The study is a global multicenter, two-arm, prospective, randomized, open, blinded end-point trial comparing functional outcomes in acute ischemic stroke patients who are treated with either intravenous tissue plasminogen activator alone or intravenous tissue plasminogen activator in combination with the Solitaire device. Up to 833 patients will be enrolled. Procedures Patients who have received intravenous tissue plasminogen activator are randomized to either continue with intravenous tissue plasminogen activator alone or additionally proceed to neurothrombectomy using the Solitaire device within six-hours of symptom onset. Study Outcomes The primary end-point is 90-day global disability, assessed with the modified Rankin Scale (mRS). Secondary outcomes include mortality at 90 days, functional independence (mRS ≤ 2) at 90 days, change in National Institutes of Health Stroke Scale at 27 h, reperfusion at 27 h, and thrombolysis in cerebral infarction 2b/3 flow at the end of the procedure. Analysis Statistical analysis will be conducted using simultaneous success criteria on the overall distribution of modified Rankin Scale (Rankin shift) and proportions of subjects achieving functional independence (mRS 0–2).
Collapse
Affiliation(s)
- Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Tisserand M, Turc G, Charron S, Legrand L, Edjlali M, Seners P, Roca P, Lion S, Naggara O, Mas JL, Méder JF, Baron JC, Oppenheim C. Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization? Stroke 2016; 47:1005-11. [DOI: 10.1161/strokeaha.115.012518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Tisserand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Guillaume Turc
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sylvain Charron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Laurence Legrand
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Myriam Edjlali
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pierre Seners
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Pauline Roca
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Stéphanie Lion
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Naggara
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Louis Mas
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-François Méder
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Claude Baron
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| |
Collapse
|
34
|
Hwang YH, Jeon JS, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes. J Neurointerv Surg 2016; 9:21-25. [PMID: 26940314 DOI: 10.1136/neurintsurg-2015-012233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/30/2016] [Accepted: 02/08/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with acute stroke and an extensive ischemic burden at baseline, the prognosis is usually poor despite timely reperfusion. OBJECTIVE To overcome universally poor outcomes in such patients, by applying immediate 'post-reperfusion cooling' in order to reduce reperfusion-related complications, and to describe the clinical and imaging characteristics. METHODS Patients having (1) an acute anterior large vessel occlusive stroke within 4.5 h since last known well, (2) Alberta Stroke Program Early CT Score (ASPECTS) ≤5 on baseline imaging, and (3) targeted temperature management with endovascular cooling after confirmed reperfusion were included in this study. RESULTS Eighteen patients (mean±SD age 59.5±10.9 years, median National Institutes of Health Stroke Scale score of 17, and median ASPECTS of 3) were analyzed. Median lesion volumes at baseline and after treatment were 130.2 and 110.6 mL, respectively. Median time from onset to the start of hypothermia and hypothermia duration were 213 min and 51 h, respectively. Favorable outcome (modified Rankin Scale ≤2) at 3 months was observed in 10 (55.6%) patients. Symptomatic intracranial hemorrhage, malignant brain edema, and pneumonia were observed in 2, 6, and 8 patients, respectively. CONCLUSIONS The use of post-reperfusion cooling as a rescue treatment in patients with substantial ischemia at baseline might improve clinical outcome.
Collapse
Affiliation(s)
- Yang-Ha Hwang
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South
| | - Ji-Su Jeon
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Dong-Hun Kang
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.,Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Yong-Sun Kim
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.,Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - David S Liebeskind
- UCLA Stroke Center, University of California, Los Angeles, California, USA
| |
Collapse
|
35
|
Kim SK, Yoon W, Park MS, Heo TW, Baek BH, Lee YY. Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke. AJNR Am J Neuroradiol 2016; 37:1080-5. [PMID: 26767711 DOI: 10.3174/ajnr.a4663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/23/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Questions remain as to what benefits embolectomy provides to patients presented with considerable early ischemic changes on baseline imaging studies. This study aimed to investigate the impact of the Alberta Stroke Program Early CT Score applied to DWI on treatment outcomes in patients with acute stroke undergoing stent-retriever embolectomy. MATERIALS AND METHODS We retrospectively analyzed the clinical and DWI data from 171 patients with acute anterior circulation stroke who were treated with stent-retriever embolectomy within 6 hours of symptom onset. DWI-ASPECTS scores were analyzed with the full scale or were dichotomized (4-6 versus 7-10). Patients with DWI-ASPECTS ≤3 were excluded from the study. Associations between outcome and clinical and radiologic factors were determined with a multivariate logistic regression analysis. A good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. RESULTS The median DWI-ASPECTS was 7 (interquartile range, 6-8). The rates of good outcome, symptomatic hemorrhage, and mortality were not different between high DWI-ASPECTS (scores of 7-10) and intermediate DWI-ASPECTS (scores of 4-6) groups. In patients with an intermediate DWI-ASPECTS, good outcome was achieved in 46.5% (20/43) of patients with successful revascularization, whereas no patients without successful revascularization had a good outcome (P = .016). In multivariate logistic regression analysis, independent predictors of good outcome were age and successful revascularization. CONCLUSIONS Our study suggested that there were no differences in outcomes between patients with a high DWI-ASPECTS and those with an intermediate DWI-ASPECTS who underwent stent-retriever embolectomy for acute anterior circulation stroke. Thus, patients with an intermediate DWI-ASPECTS otherwise eligible for endovascular therapy may not be excluded from stent-retriever embolectomy or stroke trials.
Collapse
Affiliation(s)
- S K Kim
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - W Yoon
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - M S Park
- Neurology (M.S.P.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - T W Heo
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - B H Baek
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| | - Y Y Lee
- From the Departments of Radiology (S.K.K., W.Y., T.W.H., B.H.B., Y.Y.L.)
| |
Collapse
|
36
|
Na DG, Sohn CH, Kim EY. Imaging-based management of acute ischemic stroke patients: current neuroradiological perspectives. Korean J Radiol 2015; 16:372-90. [PMID: 25741200 PMCID: PMC4347274 DOI: 10.3348/kjr.2015.16.2.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/02/2014] [Indexed: 01/05/2023] Open
Abstract
Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.
Collapse
Affiliation(s)
- Dong Gyu Na
- Department of Neuroradiology, Head & Neck Radiology, Thyroid Radiology Human Medical Imaging & Intervention Center, Seoul 137-902, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon 405-760, Korea
| |
Collapse
|